Controlling escalating drug costs means plan sponsors need to do more than just have prior authorization for high-cost drugs and restricted formularies. These programs will help, but it’s a small percentage of the employee population that actually uses the drugs.

As Chris Bonnett, president of H3 Consulting, pointed out in his presentation at yesterday’s Solutions in Drug Plan Management conference in Mississauga, Ont., chronic diseases have high prevalence and are influenced by lifestyles and by work environments. They create high personal, organizational and societal costs in drugs, work absence, disability, distraction and social services. Chronic disease rates, along with demographic and competitive pressures, mean a healthy and productive workforce is a strategic business issue worthy of executive attention.

Getting attention
But how do you get the attention of those in the C-suite? Numbers, or, more important, dollars.

Dr. Alain Sotto, chief physician, wellness division, with Ontario Power Generation (OPG), and one of the presenters at yesterday’s conference, used OPG’s numbers to drive home just how much chronic diseases cost the company every year.

In 2010, OPG spent just over $6 million between drug costs and major medical absences related to mental and behavioural disorders. The costs for metabolic syndrome (including diabetes) and cardiovascular disease were just over $5 million. Cancers cost the company just over $2 million.

Since then, awareness and pre-screening programs have been implemented, along with mandatory health and safety meetings (with the emphasis being put on health). And in just one year, the company saw results.

Mental health sick days decreased by 16%, saving the company $865,000, and cancer sick days decreased by 9% (or $129,000). While sick days for metabolic disorders increased by 4%, costing about $67,000, Sotto explained it as a matter of front-loading. “We pay now rather than paying [increased costs] later.”

Taking action
Redesigning benefits plans, better utilization of employee and family assistance programs, flu clinics, cancer screenings were all ideas that came up in discussions about what to do to control drug costs and costs to benefits plans in general.

But two very important questions were raised: what is the role of the pharmaceutical industry, and how do we make the government do something?

The first lot of ideas is clearly employer based, and since the Canadian healthcare system “doesn’t prevent disease,” as Sotto says, employers are in a good position to make real change—not just in their own population but also by forming a working group to get government attention.

There are strict rules about how information and education are disseminated by pharmaceutical manufacturers, so closer relationships need to be built between manufacturers, pharmacists, doctors and employers for meaningful change to take place.

Copyright © 2017 Transcontinental Media G.P. Originally published on benefitscanada.com

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